Characteristics of cognitive health in older adults

The stability of daily functions, the speed of cognitive decline in line with the physiological baseline corresponding to the age, and the long-term stability of emotional and behavioral patterns do not require the cognitive abilities of the elderly to be completely the same as those of middle-aged people.

When I was doing cognitive screening in a community in Xicheng District, I met 72-year-old Aunt Zhang, who was a very typical cognitively healthy elderly person. She walks two kilometers around the moat every morning, bringing soy milk and fried dough sticks to her husband and Grandma Li, who lives alone in the building. On the weekends, she organizes a group of old sisters to buy tickets to dig wild vegetables in the suburbs. She is better than many young people at editing photos on her mobile phone and doing group purchases. She scored 28 in the MMSE simple cognitive screening, which is completely in line with the cognitive baseline for the 70-75 age group. Even the doctor in charge of the screening, Jinuchi, praised her for being in good condition.

It's interesting to say that the current academic circles have not yet completely reached a consensus on the cognitive health of the elderly. Each group of scholars has their own reasons. “"Function first" scholars believe that quantitative tests are of little reference significance. As long as the elderly can independently complete daily tasks such as eating, drinking, taking care of the doctor, and paying bills, and can socialize with others normally, even if they occasionally forget to bring their keys or cannot remember what they just ate, it is not considered a cognitive abnormality. After all, aging itself is a natural process of wear and tear. However, scholars of the "baseline control group" do not see it that way. Their judgment standard is more biased towards the historical status of the elderly: If an elderly person was a top student in science when he was young, never made mistakes in accounting before, and often miscalculated money when buying things in the past year, even if his test score is still in the "normal range", as long as the decline rate exceeds the normal threshold of 0.1 standard deviation per year, it is considered a cognitive abnormality and requires early intervention. In the past two years, the views of both sides have gradually merged. Nowadays, clinical screening basically uses a combination of the two standards, and it is rare to draw conclusions based on a single result.

Many people's misunderstandings about cognitive health are actually stuck in the matter of "memory". They think that as long as the elderly forget things, there is something wrong. Last time, a family member dragged 80-year-old Uncle Wang for a screening. As soon as he entered the door, he said, "Doctor, please check if my dad has signs of Alzheimer's disease. When I asked him what he had for lunch yesterday, he thought about it for three minutes before he said it." As a result, I chatted with Uncle Wang for ten minutes. He even clearly remembered the nicknames of his comrades when he was in the army 40 years ago and the number of rounds he took for the first time. He went to the bank to make deposits every month and never missed paying utility bills. He even knew the annualized rate of return of the financial products purchased at home. Don't think this is an exception. In fact, as people age, their recent episodic memory will slowly decline, but their long-term memory will be preserved intact. This is a very normal physiological phenomenon and is not considered cognitive impairment at all.

In addition to the memory and accounting abilities that everyone can see, there is another characteristic that is easily overlooked, which is the stability of emotions and behavior. Elderly people with cognitive health may occasionally get a little angry because their children don't come home for dinner, or complain for a long time because they were charged two yuan more for grocery shopping, but the overall behavior pattern is consistent with that of previous decades: they were warm-hearted before, but now they are still willing to help their neighbors. ； I used to like square dancing, but now I still report to the square on time every day. If an old man who was originally generous suddenly becomes very stingy, hiding things every day and suspecting his family of stealing his money, or if a lively person suddenly sits at home in a daze every day and loses interest in all the things he was interested in before, then even if his memory seems to be fine, it is best to take him to the hospital for a comprehensive examination.

I have been doing cognitive intervention for the elderly for almost 6 years, and I have privately summarized a very crude judgment standard, which works with every trial: it depends on whether the elderly can have fun for themselves. Elderly people with good cognitive status can still find something to do by themselves even if their children are not around: raising a few pots of flowers can remember to water them every day, playing chess can make them blush with their old friends, even if they are watching short videos, they know how to find their favorite operas and flower gardening content, and they can also chat with their friends. If the elderly no longer even want to do their favorite things, do not want to do meals every day, or leave the house, then there is a high probability that there is something wrong with their cognitive state, so don’t take it seriously.

In fact, the cognitive level of the elderly is like that of an old house that they have lived in for decades. It is normal for the walls to peel off and the floor to have some wear marks. As long as the load-bearing walls are not crooked and the water and electricity pipes are functional, there is no need to demolish and rebuild. Staring at the peeling wall every day and worrying about it is purely to scare yourself. To put it bluntly, there is no unified standard answer to the cognitive health of the elderly. After all, everyone’s growth background and living habits are different. As long as the elderly live comfortably and their families feel no trouble, that is the best state. There is really no need to hold an online comparison chart one by one and make the whole family anxious.